Neuro-rehabilitation involves the management of life-changing neurological conditions, of sudden or more gradual onset e.g. traumatic brain injury, stroke, spinal cord injury, multiple sclerosis. Neuro-rehabilitation is a substantial component of the speciality of Rehabilitation Medicine. Neuro-rehabilitation Physicians work across the continuum of care from acute through to community. In acute hospitals, they are involved in the assessment of patients with new-onset conditions and partake in multi-disciplinary meetings on all aspects of patient management, although increasingly, they also have beds in major trauma centres to look after patients with acute traumatic brain injuries. Rehabilitation physicians may have in-patient beds in specialist rehabilitation wards or hospitals where patients tend to have a longer length of stay than in acute hospitals, usually a minimum of 6 weeks. Some rehabilitation physicians may have community posts where they have a substantial role in looking after out-patients & patients in their own homes, although this role has yet to be developed in Ireland.
The Consultant in Rehabilitation Medicine works in a team with nurses, health & social care professionals where the input of all personnel is vital. An example might be spasticity management in a stroke patient where there are several components to care e.g. management of exacerbating factors, injection of botulinum toxin, splinting, appropriate positioning in the bed and wheelchair, suitable wheelchair prescription. The neuro-rehabilitation specialist will have a good understanding of all aspects of this care.
There is a higher specialist training programme in Rehabilitation Medicine in Ireland, with some trainees also going abroad for sub-specialist training. Prior to commencing training, it is useful to have spent some time working in the speciality or in a related speciality e.g. neurology, medicine for the elderly.